Plasmakinetic Enucleation Of Prostate Research Articles

The safety and efficacy of five surgical treatments in prostate enucleation: a network meta-analysis

PurposeThe aim of our study was to investigate the comparative outcomes of five different energy types on surgical efficacy and postoperative recovery in patients with benign prostate hyperplasia.MethodsThe literature was systematically reviewed on December 1st, 2023, encompassing studies retrieved from PubMed, Embase, Web of Science, and The Cochrane Library databases that incorporated clinical studies of holmium laser enucleation of the prostate (HoLEP), Thulium:YAG laser enucleation of the prostate (ThuLEP), transurethral plasmakinetic enucleation of prostate (PKEP), diode laser enucleation of the prostate (DiLEP) and thulium fiber laser enucleation of the prostate (ThuFLEP) in the treatment of prostatic hyperplasia. Two independent reviewers extracted study data and conducted quality assessments using the Cochrane Collaboration's Risk of Bias tool and Newcastle–Ottawa Scale (NOS). Network meta-analysis (NMA) was employed to indirectly analyze the outcomes of endoscopic enucleation of the prostate (EEP) techniques.ResultsThe study included a total of 38 studies, comprising 21 non-randomized controlled trials (nRCTs) and 17 randomized controlled trials (RCTs), incorporating five distinct techniques: holmium laser, Thulium:YAG laser, bipolar plasma, diode laser and thulium fiber laser. In comparing treatment durations, ThuLEP and HoLEP had shorter overall hospital stays than PKEP, while the enucleation time of ThuLEP and HoLEP was shorter than that of ThuFLEP. Moreover, the enucleation tissue weight of both thulium fiber laser and holmium laser was heavier than bipolar plasma. However, the analysis did not reveal any statistically significant variation in complications among the various types of enucleation. In postoperative follow-up, the IPSS at 3 months post-operation was superior in the Thulium:YAG laser group compared to the holmium laser group. The thulium fiber laser technique demonstrated significant advantages over other enucleation methods in terms of QoL and PVR at 12 months after surgery.ConclusionTheoretical properties may vary among different energy sources; however, there are no discernible clinical differences in operation-related parameters, postoperative complications, and postoperative follow-up. Therefore, the choice of laser does not significantly impact the outcome. However, due to the limited number of included studies, future research should focus on larger sample sizes and multicenter investigations to further validate the findings of this study.

Clinical practice guideline for transurethral plasmakinetic resection of prostate for benign prostatic hyperplasia (2021 Edition)

Benign prostatic hyperplasia (BPH) is highly prevalent among older men, impacting on their quality of life, sexual function, and genitourinary health, and has become an important global burden of disease. Transurethral plasmakinetic resection of prostate (TUPKP) is one of the foremost surgical procedures for the treatment of BPH. It has become well established in clinical practice with good efficacy and safety. In 2018, we issued the guideline “2018 Standard Edition”. However much new direct evidence has now emerged and this may change some of previous recommendations. The time is ripe to develop new evidence-based guidelines, so we formed a working group of clinical experts and methodologists. The steering group members posed 31 questions relevant to the management of TUPKP for BPH covering the following areas: questions relevant to the perioperative period (preoperative, intraoperative, and postoperative) of TUPKP in the treatment of BPH, postoperative complications and the level of surgeons’ surgical skill. We searched the literature for direct evidence on the management of TUPKP for BPH, and assessed its certainty generated recommendations using the grade criteria by the European Association of Urology. Recommendations were either strong or weak, or in the form of an ungraded consensus-based statement. Finally, we issued 36 statements. Among them, 23 carried strong recommendations, and 13 carried weak recommendations for the stated procedure. They covered questions relevant to the aforementioned three areas. The preoperative period for TUPKP in the treatment of BPH included indications and contraindications for TUPKP, precautions for preoperative preparation in patients with renal impairment and urinary tract infection due to urinary retention, and preoperative prophylactic use of antibiotics. Questions relevant to the intraoperative period incorporated surgical operation techniques and prevention and management of bladder explosion. The application to different populations incorporating the efficacy and safety of TUPKP in the treatment of normal volume (< 80 ml) and large-volume (≥ 80 ml) BPH compared with transurethral urethral resection prostate, transurethral plasmakinetic enucleation of prostate and open prostatectomy; the efficacy and safety of TUPKP in high-risk populations and among people taking anticoagulant (antithrombotic) drugs. Questions relevant to the postoperative period incorporated the time and speed of flushing, the time indwelling catheters are needed, principles of postoperative therapeutic use of antibiotics, follow-up time and follow-up content. Questions related to complications incorporated types of complications and their incidence, postoperative leukocyturia, the treatment measures for the perforation and extravasation of the capsule, transurethral resection syndrome, postoperative bleeding, urinary catheter blockage, bladder spasm, overactive bladder, urinary incontinence, urethral stricture, rectal injury during surgery, postoperative erectile dysfunction and retrograde ejaculation. Final questions were related to surgeons’ skills when performing TUPKP for the treatment of BPH. We hope these recommendations can help support healthcare workers caring for patients having TUPKP for the treatment of BPH.

Predictors of Storage Symptom Improvement After Plasma Kinetic Enucleation of the Prostate

ObjectiveTo investigate which preoperative findings portend poor improvement in storage symptoms in patients undergoing plasma kinetic enucleation of prostate (PKEP). MethodsA single surgeon series of patients who had undergone PKEP with minimum 1 year follow up were evaluated. Patients were grouped into those with less than 33% improvement in storage symptoms (LIS) according to the international prostate symptom score (IPSS) and those with greater than 33% improvement in storage symptoms (GIS). Pre and postoperative factors were evaluated, along with IPSS, storage symptoms percentage (the total from frequency, urgency and nocturia divided by the total IPSS), bother index, and post void residual (PVR) at 6 weeks, 4 months, and yearly. ResultsTwo hundred sixty-eight patients had a minimum 1 year of follow up and had completed the IPSS. IPSS and bother index improved significantly from preoperatively to all time points post operatively in both groups, but the difference was greater in the GIS group. Patients in the GIS group had significantly larger prostates, more prostatic ingrowth, higher preoperative PVR, and a higher overall IPSS compared to the LIS group. Those in the LIS group had a higher incidence of prior prostate surgery, and a higher BMI. However, storage symptom percentages were equal between the GIS and LIS groups at all time points. ConclusionGreater prostatic ingrowth, larger prostate volume, higher preoperative PVR volume, and a higher overall IPSS was associated with greater improvement in storage symptoms. Prior prostate surgery and higher BMI portend less improvement in storage symptoms.

Application of Two New Feature Fusion Networks to Improve Real-time Prostate Capsula Detection.

Excess prostate tissue is trimmed near the prostate capsula boundary during transurethral plasma kinetic enucleation of prostate (PKEP) and transurethral bipolar plasmakinetic resection of prostate (PKRP) surgeries. If a large portion of the tissue is removed, a prostate capsula perforation can potentially occur. As such, real-time accurate prostate capsula (PC) detection is critical for the prevention of these perforations. This study investigated the potential for using image denoising, image dimension reduction and feature fusion to improve real-time prostate capsula detection with two objectives. First, this paper mainly studied feature selection and input dimension reduction. Secondly, image denoising was evaluated, as it is of paramount importance to transient stability assessment based on neural networks. Two new feature fusion techniques, maxpooling bilinear interpolation single-shot multibox detector (PBSSD) and bilinear interpolation single shot multibox detector (BSSD) were proposed. Before original images were sent to the neural network, they were processed by principal component analysis (PCA) and adaptive median filter (AMF) for dimension reduction and image denoising. The results showed that the application of PCA and AMF with PBSSD increased the mean average precision (mAP) for prostate capsula images by 8.55% and reached 80.15%, compared with single shot multibox detector (SSD) alone. Application of PCA with BSSD increased the mAP for prostate capsula images by 4.6% compared with SSD alone. Compared with other methods, ours were proven to be more accurate for real-time prostate capsula detection. The improved mAP results suggest that the proposed approaches are powerful tools for improving SSD networks.

Curative effect of plasmakinetic enucleation of prostate in the treatment of large volume prostate

Objectives To evaluate the clinical effect of transurethral plasmakinetic enucleation of the prostate (PKEP) in treatment of large volume benign prostatic hyperplasia(BPH) (>80mL). Methods The clinical date of 80 patients with large volume BPH in the hospital from May 2012 to January 2015 were analyzed retrospectively. All patients were divided into PKEP group(n=37) and transurethral bipolar plasma kinetic prostatectomy (TUPKP group) (n=43) according to surgical ways. Perioperative indices, postoperative follow-up results of two groups were compared and ana- lysed. Results Bladder washing time (20.5 ± 6.7 )min, blood loss (120.5± 44.9 )mL, indwelling catheter time (4.4 ± 1.9)d, postoperative hospitalization (5.2 ±1.8)d in PKEP group were significantly lower than in TUPKP group and resection of the prostate weight (63.2± 21.5) g was significantly higher than TUPKP group (P 0.05). Qmax (22.4±4.7) mL/s in PKEP group was significantly higher than that in TUPKP group (19.5±4.0) mL/s (P 0.05), and the PSA values of the two groups were significantly decreased (P<0.05). The postoperative complication rate (62.16%) in the PKRP group was significantly lower than that in the TUPKP group (86.05%) and the difference was statistically significant (P<0.05). Conclusions PKEP has good clinical effect in the treatment of large volume BPH and TUPKP, it has the advantages of less bleeding, quick recovery and low complications. Key words: Prostatic Hyperplasia; Transurethral Resection of Prostate

Plasmakinetic enucleation of the prostate: the complication and outcome according to the prostate size

Objective To evaluate surgical complications and outcomes based on prostate size in patients with benign prostatic hyperplasia (BPH) treated with plasmakinetic enucleation of prostate (PKEP). Methods A retrospective review was conducted of PKEP performed in 326 patients with BPH. According to the prostate size on preoperative transrectal ultrasonography measurement, patients were divided into three groups: group 1: 80 ml (n=79). Intraoperative and perioperative parameters were evaluated. Patient perioperative data and postoperative outcomes were compared. Patients were followed up at 1, 3, 6 and 12 months after surgery. Early and late complications were recorded. Results There were significant differences among three groups regarding the mean operative time (P 0.05), mean serum sodium decrease (P>0.05), mean postoperative irrigation time (P>0.05), mean catheter time (P>0.05) and mean hospital stay (P>0.05) did not differ significantly among three groups. Three groups had a similar and significant postoperative improvement in international prostate symptom score (IPSS), quality of life (QOL), maximum urine rate (Qmax), and post-void residual urine volume(PVR) independent of prostate size (P 0.05). Perioperative and postoperative complications did not depend on prostate size (P>0.05). Conclusions Although patients with a larger BPH required significantly longer operation time in PKEP, prostate size did not affect perioperative and postoperative complications or micturition improvement. Key words: Prostate; Prostatic hyperplasia/SU; Transurethral resection of prostate

AB016. Transurethral PlasmaKinetic enucleation of prostate versus transurethral PlasmaKinetic resection of prostate for benign prostate hyperplasia

BackgroundTo compare the efficacy and safety of transurethral PlasmaKinetic enucleation of prostate (PKEP) versus transurethral PlasmaKinetic resection of prostate (PKRP) for benign prostate hyperplasia.MethodsThe Prospective and randomized controlled trials (RCTs) pertaining to PKEP and PKRP for benign prostate hyperplasia were retrieved from PubMed, Wanfang and so on. The level of trials was assessed by using Cochrane system.ResultsCompared with PKRP, the time of operation shorten 10.17 min, the time of catheterization and hospital stay shorten 22.30 h, 1.33 d respectively. The volume of intraoperative bleeding decreased 47.34 mL. The quantity of resectable prostate increase 10.76 g, difference is statistically significant (P<0.05). Compared with PKRP, the international prostate symptom score (IPSS) was lower after 3 months, the quality of life (QOL) and residual urine volume (RUV) was lower after 6 months, the maximum floe rate (Qmax) was higher after 3 and 6 months, difference is statistically significant (P<0.05). No significant differences were found in IPSS, QOL, Qmax, RUV, international index of erectile function 5 (IIEF-5) between PKRP and PKEP after 1 and 2 years. The incidence of transfusion and capsular perforation was lower than PKRP, but the incidence of postoperative Transient urinary incontinence was higher than PKRP.ConclusionsCompared with PKRP, PKEP cause less blood loss and requires a shorter operation time, a shorter catheterization time and a shorter hospital stay. It resects the proliferated prostate more cleanly with lower incidence of capsular perforation, but the incidence of postoperative transient urinary incontinence was higher. The short-term efficacy of PKEP was better than PKRP, but no significant differences were found in long-term efficacy and the postoperation influence of sex function between PKEP and PKRP.

A prospective study of transurethral resection of prostate and transurethral enucleation of prostate for benign prostatic hyperplasia according to different weights of prostate

Objective To compare the clinical effect of transurethral plasma kinetic enucleation of prostate (TPKEP) and transurethral resection of prostat (TURP) for benign prostatic hyperplasia (BPH) according to different weights of prostate.Methods 245 cases of BPH were divided into two groups randomly.122 cases underwent TURP and 123 cases underwent TPKEP.All cases were divided into three subgroups:67 cases in ＜40 g group,96 cases in 40-70 g group and 82 cases in ＞70 g group,according to different weights of prostate.Perioperative parameters and short-term outcomes between two groups were compared.Results In the ＜40 g subgroup there was no significant difference between two groups in perioperative factors and short-term outcomes (P＞0.05).In the 40-70 g subgroup,tissue resected by TPKEP was significantly more than that by TURP (30.2± 13.1 g versus 30.2± 13.1 g,P＜0.05).The intraoperative blood loss was less in TPKEP group than that in TURP group (70.1±10.4 ml versus 81.3±11.3 ml,P＜0.05).The decline of prostate specific antigen (PSA) was more dramatically in TPKEP group than that in TURP group after 3 months (2.6±0.3 μg/L versus 2.1±0.6 pg/L,P＜0.05).In the ＞70 g subgroup,the decline of PSA level was (3.4±0.3) μg/L after 3 months in TPKEP group,more than (2.3±0.7) μg/L in TURP group (P＜0.05).The increase of Qmax after 3 months in TPKEP group was (18.6±3.5) ml/s,more than (16.6±3.4) ml/s in TURP group (P＜0.05).There was no significant difference between the two groups in international prostate symptoms score and residual urine volume (P＞0.05).The transfusion rate for TPKEP (3 ca-ses) were lower than that for TURP (12 cases) (P＜0.05),but the incidence of false incontinence for TPKEP (17 cases) were higher than that for TURP (6 cases) (P＜0.05).Conclusions Compared with TURP,TPKEP resect the entire prostate with the advantages of less blood loss and more effective for a large prostate.TPKEP had no advantage for small prostate,and the medical results are equivalencies in prostate with medium size. Key words: Transurethral plasma kinetic enucleation of prostate; Transurethral resection of prostate; Prostatic hyperplasia; Prospective studies

Comparison of Fluid Absorption between Transurethral Enucleation and Transurethral Resection for Benign Prostate Hyperplasia

Introduction: Although transurethral resection of prostate (TURP) remains the reference standard for benign prostate hyperplasia (BPH), the concern about complications promotes researchers to develop alternative surgical methods with fewer complications. In this study, we compared the safety and efficacy between the transurethral plasma kinetic enucleation of prostate (TUPKEP) and transurethral plasma kinetic resection of prostate (TUPKRP), mainly including absorption of irrigation fluid, the operation time, the weight of prostate tissue removed and severe complications. Methods: Sixty BPH patients were randomly and evenly assigned to the TUPKEP or TUPKRP group. The irrigation fluid used in both groups was 1% ethanol-containing saline solution. The ethanol concentrations in the subjects' end expiration were measured during operation. The volume of irrigation fluid absorbed was calculated accordingly. Results: No significant difference was found in operation time between two groups, whereas the weight of prostate tissue resection was significantly higher in the TUPKEP than that in the TUPKRP group. Conclusion: The study provides evidence for the safety, feasibility and effectiveness of both bipolar transurethral techniques. Further, compared to the TUPKRP group, the TUPKEP group has more efficient for resection of prostatic hyperplasia tissue, even though in terms of fluid absorption, no difference has been found in both groups. Ethanol monitoring is simple, safe and effective, which is beneficial for enhancing safety procedures.

The efficacy of transurethral plasmakinetic enucleation of prostate plus suprapabic lithotomy for elder patients with benign prostatic hyperplasia and multiple bladder stones

Objective To explore the efficacy of transurethral plasmakinetic enucleation of prostate in combination with suprapabic lithotomy for elder patients with benign prostatic hyperplasia and multiple bladder stones. Methods Transurethral plasmakinetic enucleation of prostate in combination with suprapabic lithotomy was performed on 13 elder patients with benign prostatic hyperplasia and multiple bladder stones. Results All the patients received active postoperative treatment for complications. After their general health status became better, transurethral plasmakinetic enucleation of prostate was performed prior to suprapabic lithotomy. All the patients safely spent the perioperative period and had normal postoperative urination and no incision infection. Conclusions Transurethral plasmakinetic enucleation of prostate plus suprapabic lithotomy for benign prostatic hyperplasia and multiple bladder stones is simple and effective, has smaller incisions and shorter surgical duration, and is worth popularizing. Key words: Transurethral plasmakinetic enucleation of prostate ; Benign prostatic hyperplasia; Multiple bladder stones

Randomized trial comparing holmium laser enucleation of prostate with plasmakinetic enucleation of prostate for treatment of benign prostatic hyperplasia

Objectives To compare the alternative energy sources of the holmium:yttrium-aluminum-garnet laser and bipolar plasmakinetic energy for endoscopic enucleation. Methods A prospective, randomized controlled trial was undertaken, with 20 patients assigned to each group. The preoperative and postoperative measures included transrectal ultrasound-assessed prostate volume, postvoid residual urine volume, and urodynamic evaluation findings. The intraoperative measures included procedure length, energy use, and specimen weight. All adverse events were recorded at each postoperative visit in a 1, 3, 6, and 12-month protocol. Results No differences were found in the preoperative characteristics between the two groups. The significant differences favoring holmium laser enucleation of the prostate compared with plasmakinetic enucleation of the prostate were seen in the operative time (43.6 versus 60.5 minutes), recovery room time (47.1 versus 65.6 minutes), and bladder irrigation requirement (5% versus 35%). The outcomes after holmium laser enucleation of the prostate and plasmakinetic enucleation of the prostate were in all other respects similar by the postoperative outcome measures assessed. Conclusions Plasmakinetic enucleation of the prostate is a safe and technically feasible procedure for the enucleation of prostatic adenomata. Plasmakinetic enucleation of the prostate is limited by the longer operative and recovery room times, as well as a more pronounced postoperative irrigation requirement because of reduced visibility and a greater propensity for bleeding. The transfusion rates and catheterization and hospitalization times were similar. The optimal energy source for enucleation should still be considered the holmium laser, but bipolar energy can be considered by users already experienced with holmium laser enucleation of the prostate.